WEBVTT

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This technique video focuses on the

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treatment of adults with chronic

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sialorrhea using

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XEOMIN (incobotulinumtoxinA).

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Treatment of chronic sialorrhea

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involves the identification of

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specific anatomic areas, which

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can be identified by using anatomic

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landmarks or through use of

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ultrasound guidance.

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This video will demonstrate how to

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identify each injection site using

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ultrasound guidance.

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Once the gland is located,

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XEOMIN is administered to each

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injection site for the treatment of

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chronic sialorrhea in an adult

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patient.

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Please see the end of the video for

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important safety information,

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including boxed warning.

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XEOMIN is injected into the parotid

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and submandibular glands on both

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sides of the face.

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This is accomplished through four

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identified injection sites per

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treatment session.

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The total FDA approved dose per

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treatment session is 100 units.

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The total 100U dose is divided

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with a ratio of 3 to 2 between

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the parotid gland and the

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submandibular gland.

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30 units are injected to the parotid

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gland on each side and 20 units are

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injected to submandibular gland on

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each side.

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Please note for these demonstration

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purposes, the individual is

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not a real patient and is injected

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with saline.

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The model has been properly

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consented, pre-treatment photographs

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have been obtained and the skin in

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the treatment areas has already been

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prepped.

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While care has been taken to confirm

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the accuracy of the information

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presented in this video.

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And consistency with the FDA

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approved use of XEOMIN in the

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treatment of an adult with chronic

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sialorrhea, all information

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provided is necessarily generic

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in nature and does not constitute

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continuing medical education or

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medical advice.

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The parotid glands are superficial

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structures and readily amenable to

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high resolution ultrasound

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examination.

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The normal parotid gland appears

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homogenous and has increased

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echogenicity relative to the

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adjacent muscles on ultrasound.

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This increased echogenicity is

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related to the fatty glandular

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tissue composition of the parotid.

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To identify the injection site of

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the parotid gland, find the midpoint

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on the line connecting the tragus

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and mandible angle, approximately at

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the height of the earlobe one finger

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breadth anterior to this.

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A single injection site in the

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middle of the gland is required and

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in general, the injection depth

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should be no more than 0.5

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to 1.0 centimeters, depending

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on the thickness of the tissue.

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Tissue thickness can vary from

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patient to patient, secondary to

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the patient's nutritional status.

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Upon insertion, the needle cannot be

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readily visualized, however the

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injection volume can be seen with

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weak echoing as a black fluid within

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the gland.

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This same procedure should be

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followed on the patient's

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contralateral side.

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The normal submandibular gland shows

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homogenous echo texture and fine

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soft tissue echogenicity.

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It is hypoechoic as compared to

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the surrounding tissue and is

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similar to the echogenicity of

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muscle.

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The submandibular gland show almost

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the same texture and echogenicity of

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the parotid gland.

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The border between the glands can be

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clearly seen as conjunctive tissues

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and more echogenic than glandular

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tissue.

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To determine the injection site for

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the submandibular gland, locate the

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midpoint between the angle of the

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mandible and the tip of the chin.

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Deliver the injection one finger

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breadth medial to the inferior

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surface of the mandible at this

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site.

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The needle is inserted upwards and

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forward in the direction of the

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mouth floor in a 70 to 90 degree

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angle to the mandibular arch.

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A single injection site in the

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middle of the gland is required and

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in general the injection depth

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should be no more than 0.5

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to 1.0 centimeters,

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depending on the thickness of the

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tissue.

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Tissue thickness can vary from

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patient to patient.

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Secondary to the patient's

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nutritional status.

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Upon insertion, the needle cannot be

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readily visualized.

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However, the injection volume can be

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visualized with weak echoing as

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black fluid within the gland.

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This same procedure should be

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followed on the patient

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contralateral side.